- Thumb:
- typical problems: stability and retractability;
- thumb adduction stop used to gain ROM in first web space;
- rigid thumb orthosis allows for stabilizing thumb for prehension;
- MP Joints:
- usually a hand orthosis;
- with no active extension of the MP joints, use rubber bands with line of pull perpendicular to the shaft of bone;
- Peripheral Neuropathies:
- Ulnar Nerve at the Wrist:
- intrinsic muscle paralysis w/ hyperextension of MP joints & flexion of the IP joints "ulnar claw hand;"
- MP extension stop replaces intrinsic weakness & allows extension of IP joints;
- Median Nerve Palsy:
- problem: loss of thumb opposition and sensation;
- hand orthosis with opponens bar and MP stop;
- Radial Nerve:
- loss of extension of wrist and MP joints;
- need to assist wrist extension - dynamic or static wrist extensors may be used;
- MP joints should have extension assist;
- Spinal Cord Injuries:
- C-8 escape:
- opposition and intrinsic muscle function absent;
- possible to use static hand orthosis with MP stop;
- person will use their own natural tenodesis action;
- C-7 escape:
- proximal stability present;
- loss of grasp;
- wrist extensor present (power source)
- use wrist driven flexion hinge;
- persons may use their own natural tenodesis;
- C-6 escape:
- proximal stability present;
- loss of grasp
- good candidate for flexor hinge hand splint;
- C-5 escape:
- proximal stability present
- no wrist extensors available to power the orthosis;
- may use external power system, usually electric power with switch control